Abstracts

South West Surgical Club Meeting, Bath, 2nd and 3rd November, 1979 Chairman: Mr. Harry Wingfield, F.R.C.S. HYPERCALCIURIA AND BRAIM

In five years over 300 undoubted, fully investigated stone-formers were examined in Bath, of whom over 100 had hypercalciuria. Lowering the urinary calcium is generally accepted as being a useful measure in patients with hypercalciuria, and sodium cellulose phosphate was used at first. However patients found the powder unpalatable; it is also relatively expensive. It  open-staging lymphadenectomy. Patients were treated by orchidectomy. In 41 patients this was combined with radiotherapy including pelvic and para-aortic lymph nodes up to the level of the diaphragm. In common with other studies, the results of treating seminoma were good, but those with teratoma were depressing. Recent studies suggest a combination of radio-and chemotherapy may improve the results. The high mortality and morbidity associated with resection of advanced benign oesophageal strictures has provoked consideration of alternatives. The Celestin tube has been found useful in such cases either as a temporary indwelling dilator or left permanently in situ. At Southmead Hospital, Bristol and Royal United Hospital, Bath, from 1966Bath, from to 1976 Celestin tubes were used in two groups of patients with advanced benign oesophageal strictures: 1. 22 elderly, poor-risk patients (average age 76) in whom intubation alone, via a gastrotomy, provided good symptomatic relief of dysphagia. 2. 11 younger, better-risk patients (average age 63) in whom the tube was used as a temporary indwelling dilator combined with repair of a hiatus hernia.
Following removal at a mean of 5 months post-operatively, 73% of patients remained free of recurrence when followed for 2 years. There were 5 deaths in the first group of patients, but in only one of these might it have been related to tube insertion.
There were no deaths in the second group. Our aim has been to encourage the referal of patients with cryptorchidism for a surgical opinion around the age of 4 to 5 years so that definitive treatment can be carried out before degenerative changes occur which might prevent adequate spermatogenesis at puberty.
In all patients presenting over a year an attempt was made at the initial examination to classify them into those with retractile testes, those with truly undescended testes lying in the path of normal descent, and those with ectopic testes lying in the superficial pouch above and lateral to the external ring. Gonadotrophin therapy (500 units Im twice weekly for 6 weeks) was considered only for those boys whose testes lay along the the pathway of normal descent but could not be palpated below the neck of the scrotum.
12 patients were orginally diagnosed as having unilateral undescended testes; 3 (25%) descended following a course of gonadotrophins. 9 patients had bilateral cryptorchidism; they were particularly difficult to assess due to the obesity and scrotal hypoplasia which were frequently present. In 4 patients, however, both testes descended following a course of gonadotrophin injections. In a further 3 patients one side was descended. In this group, therefore, 11 (61%) out of a possible 18 testes descended and the remaining patients required orchidopexy.

THE USE OF DOPPLER ULTRASOUND IN THE ASSESSMENT PATIENTS WITH PERIPHERAL VASCULAR DISEASE
A. R. Turnbull Blood flow may be determined from the Doppler shift of ultrasound waves, but the measurement is very complex. The pulsatility index, rise time and transit time can however be determined more easily during simultaneous measurements at the proximal and distal ends of an artery. This has been assessed over the femoro-popliteal segment in 123 patients by comparing the results of Doppler ultrasound with arteriograms. Measurements were also made in 43 asymptomatic patients giving a total of 89 results from control arteries and 228 from patients. Arteriography in the patients showed an additional 63 normal segments, 102 complete blocks and 60 with varying degrees of atheromatous change; 3 had been previously bypassed. The damping factor, which is the ratio of the pulsatility indices at the proximal and distal ends of the arteries, and rise time ratios were plotted against transit time. The results showed that there was a clear distinction between normal arteries and those with a tight stenosis or complete block, but the technique did not discriminate between normal arteries and mild atheromatous changes. The differences were similar when the damping factor or the rise time ratio was plotted against transit time, but the rise time was simpler to calculate.

K. Lloyd Williams, Barbara Phillips
Mammography is favoured for screening as it can detect impalpable tumours. Though mammography is considered to have a specificity and sensitivity of 90%, it has a poor predictive value when used to screen a large, asymptomatic population. A means is required therefore for selecting the patients in which most, and ideally all of the cancers will be found. Convential thermography has an even poorer predictive value but, if a computer is used to apply a consistent over-reading, specificity can be increased. If the positive group only is X-rayed, the predictive value of mammography will, in theory, be improved.
To determine whether such pre-selection works in practice, aided by the DHSS, we examined 5,672 women using clinical examination and thermography. 20% were thermally positive and were X-rayed together with women in whom there was a clinical abnormality or strong family history. In all 25% of all the patients were X-rayed. 41 cancers were found giving a pick-up rate of 7.2 per 1,000. This result was similar to other surveys in which the whole sample was X-rayed, and agrees with calculated prevalence rates.